Post-9/11, HHS learned how to answer states' needs

Emily Kopp, reporter, Federal News Radio

When terrorists destroyed the World Trade Center on Sept. 11, 2001, federal medical workers rushed to the scene. But they caught state officials off guard.

"Volunteers started showing up without being asked for. We were sending federal resources and the states didn't necessarily know they were coming," said Ann Knebel, Health and Human Services deputy director of preparedness planning.

Knebel was one of the medical volunteers who came to help at Ground Zero. Arriving 10 days after Sept. 11, she ended up caring for rescue workers rather than victims.

"The most important lesson over the past 10 years has really been the massive amount of coordination that it takes, both from the federal government — all the interagency partners — as well as the state and local partners in terms of having an integrated capacity to respond to any sort of emergency," said HHS deputy assistant secretary for preparedness and response George Korch.

In the immediate post 9/11 environment, Knebel said HHS' preparedness and response team was hamstrung. The agency had ceded to the Homeland Security Department the national disaster medical system, by which it coordinates with hospitals and mobilizes medical workers.

"It required us to take a step back and do an analysis and the decision was made that the national disaster medical system needed to be in HHS so the whole medical toolkit would be in one department rather than split between departments," she said.

Today, that toolkit also includes regional coordinators who walk through disaster scenarios with state counterparts. They imagine what would happen in a terrorist attack or hurricane, for example. They figure out what resources the state already has, what it can get from neighboring states and what the federal government would have to provide.

States have used federal grants to prepare for emergencies, too.

Korch said one example of how far things have come over the last decade was in the response to the tornado that destroyed the hospital in Joplin, Mo., in May.

He said Missouri had bought a mobile hospital and put it in place right away. They also had used federal funds to create electronic medical records that were instantly available.

While that was a far smaller disaster than 9/11, Knebel said it showed that all the coordination has paid off and the federal government really understood what the state needed.

"Unlike 9/11, we weren't just pushing supplies and equipment out there and the state having to figure out what to do with what they got sent," she said. "We had much better visibility of what they would need and it ended up what they needed wasn't any medical assistance teams. What they needed was mortuary assistance teams."

She said federal workers also helped identify the dead.

But it took many years to fix some of the post-9/11 challenges. In the aftermath of the attacks, Congress created the Homeland Security Department and consolidated emergency preparedness and response functions. Kneble said the government went overboard.

"In the aftermath of 9/11, there were all kinds of legislative initiatives. There were Presidential directives and many of those initiatives slowed us down in terms of acting on lessons learned from 9/11," she said.

That mistake became clear in 2005, when Hurricane Katrina blew through the Gulf. Thousands of people suffered while government entities argued about the best response.

Since Katrina, Kneble said coordination and communication from federal agencies to states and vice versa is much better. But that coordination and speed comes at a price.

"In times of budget crisis, the erosion of what you've built up is always a danger," said Korch. "We're are seeing that to a certain degree at the state levels as the states are struggling with their budgets to be able to have robust public health system."
He said state and local governments recently cut as many as 40,000 public health jobs.

"How much money do you invest in preparedness when you have more immediate needs?" Knebel asked. "I think there's a bit of complacency that sets in."

But she said she believes that cutting funds for disaster preparedness would leave the country more vulnerable.